Abstract
The roots of Kaiser Permanente go back nearly 70 years to the building of the Los Angeles Aqueduct, Washington's Grand Coulee Dam, and the West Coast shipbuilding efforts of World War II. The key elements of managed care organizations today-prepayment, preventive care, and group practice-were part of the founding principles of Kaiser Permanente. This article provides a historical perspective of how Kaiser Permanente evolved from these roots to become the largest nonprofit health maintenance organization in the United States. It further describes Kaiser Permanente's fully integrated health care program and offers pragmatic examples of how integrated care is delivered.